Headlines

As reported by the Danbury News-Times, December 27, 2007.

Connecticut May Have Extra Protection Against Mumps Outbreak

By Robert Miller

The mumps -- one of those childhood diseases that seemed to be all but eradicated -- is back, spreading this year from the Maritime Provinces of Canada to Maine, where more than 70 adults and children have been diagnosed this month.

But Connecticut may have an extra protection against the disease -- it requires all students to get a booster shot of the measles-mumps-rubella (MMR) vaccine by age 12 years. Children must receive their first MMR shot between ages 12 to 15 months.

"There are some states that require a second MMR vaccination and Connecticut is one of them," said Dr. Frederick Browne, head of the department of infectious diseases at New Milford Hospital.

"We are monitoring the disease, as always," said Diane Lejardi, spokeswoman for the state Department of Public Health on Wednesday. "Right now, there's not so much concern. If it were to move closer, there would be."

"If you get one shot of the vaccine, that gives you 80-percent protection," said Dr. Gary Schleiter, chief of the infectious disease department at Danbury Hospital. "If you get two shots, it gives you 90-percent protection. So the higher level of vaccination we have, the more it will help."

But Dr. John Shanley, professor emeritus of infectious diseases at the University of Connecticut School of Medicine in Farmington and former head of its infectious diseases department, said recent outbreaks of mumps in Europe and in the U.S. may be another example of childhood vaccines waning as people age.

"There's a lot of attention now being paid to adult vaccination, and we'll see more," Shanley said.

Because of the Maine outbreak, other New England states -- New Hampshire, Vermont and Massachusetts -- have issued warnings, alerting health care providers to be on the lookout for new cases.

The Canadian Maritime Provinces have reported 1,140 cases of mumps in recent months. Europe also had an outbreak in 2005, and the Midwest in 2005 and 2006, reported more than 6,500 cases. That contrasts to previous years, when the Centers for Disease Control and Prevention recorded about 250 to 300 cases per year nationwide.

Mumps is a contagious viral disease, related to measles. It's spread from person to person by coughing or sneezing. While thought of as a children's illness, many of today's outbreaks are centered around college dorms, where many students share living and eating quarters.

"You're talking about wherever there are groups of people together -- in colleges, in technical schools, in hospitals and health care settings, even cruises," Browne said.

"It's an incredibly infectious agent," Shanley said of the virus.

With mumps, people usually get swollen salivary glands on both sides of their neck, along with a fever, fatigue and muscle aches. In most cases, patients recover after about a week of discomfort without complications. Shanley said 15 to 20 percent of the population exposed to the virus develop only mild symptoms.

But in people who contract the mumps after puberty, complications can follow, including inflammation of the testicles in males and inflammation of the breasts and ovaries in females. It can also cause inflammation of the brain or its covering and inflammation of the pancreas.

Most people who are in their 50s or older got mumps as a child. They're immune from the disease. But in the late 1960s, the MMR vaccine became readily available and by the mid-1970s became one of the required childhood vaccines. As a result, cases of all three of these disease plummeted.

No one is really sure what's causing the new outbreaks.

"All we know is that it's happening," of Danbury Hospital's Schleiter said.

In a paper Shanley published last January in the Cleveland Clinic Journal of Medicine, he pointed out that in the 2005-06 outbreak in Iowa about half the patients had two shots of the vaccine and 12 percent had received one dose. That differed from an outbreak in Great Britain that affected more than 50,000 people -- most ages 15 to 24 -- where the vaccination rate was much lower.

What may be happening, Shanley said, is that as people age the power of childhood vaccines starts to wane. In recent years, there's been a similar re-emergence of pertussis -- whooping cough -- in adults who received a childhood vaccination to prevent it.

But vaccinating people to stop the spread of infectious diseases isn't easy. Most adults don't know what vaccines they received as a child, Shanley said, and they don't always want to get new ones.

"We're getting very good at inoculating children," he said. "But getting adults to get vaccinated can be a tricky subject. I run an adult vaccination and travel clinic at UConn. Most people have no record of when they were vaccinated for anything."